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Path Y > Histopathology - Upper GI disease > Flashcards

Histopathology - Upper GI disease Flashcards

1
Q

What is the “Z line” in the GI tract?

A

Normal appearance of squamo-columnar junction (epithelium transitions from squamous to columnar)

Z line in the oesophagus is the term for a faint zig-zag impression at the gastro-oesophageal junction that demarcates the transition between the stratified squamous epithelium in the oesophagus and the intestinal epithelium of the gastric cardia (the squamocolumnar junction)

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2
Q

Where is the cardia portion of the stomach?

A

Junction between oesophagus and stomach

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3
Q

What are the 3 layers of the stomach wall?

A 
Gastric mucosa (columnar) 
Lamina propria (containing glands) 
Muscularis mucosa
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4
Q

In a normal duodenum, what is the villous:crypt ratio?

A

3:1

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5
Q

Where are goblet cells usually found?

A

Intestine

(NOT in stomach)

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6
Q

What is the most common cause of acute oesophagitis?

A

GORD

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7
Q

If reflux oesophagitis causes a perforation of the oesophagus, what will be the result?

A

Mediastinitis

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8
Q

What are the 4 most common complications to remember of most GI pathologies?

A

Ulceration
Haemorrhage
Perforation
Stricture

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9
Q

What is gastric metaplasia?

A

type of CLO without goblet cels
Metaplastic change in oesophagus WITHOUT goblet cells

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10
Q

What is intestinal type metaplasia?

A

type of CLO with goblet cells
Replacement of squamous epithelium with metaplastic columnar epithelium WITH goblet cells present
higher cancer risk in this type

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11
Q

What is the most common sequence of pathological progression to cancer in the upper GIT?

A

Metaplasia –> dysplasia –> Cancer

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12
Q

What is the most common type of oesophageal cancel?

A

Adenocarcinoma

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13
Q

Where does adenocarcinoma of the oesophagus usually develop?

A

bottom 1/3 of oesophagus

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14
Q

Which type of oesophageal cancer is most strongly associated with GORD & Barrett’s?

A

Adenocarcinoma

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15
Q

What is the most common type of oesophageal cancer in developing coutries?

A

Squamous cell carcinoma

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16
Q

Which type of oesophageal cancer is most associated with smoking and alcohol?

A

Squamous cell carcinoma

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17
Q

Where in the oesophagus does squamous cell carcinoma tend to present?

A

upper 2/3 of oesophagus

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18
Q

Why is prognosis for oesophageal carcinoma particularly poor?

A

Most patients are not suitable for resection surgery

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19
Q

What other condition are oesophageal varices particularly associated with?

A

Portal vein stenosis/hypertenion

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20
Q

What are the 3 main causes of acute gastritis?

A

Aspirin/NSAIDs
Alcohol
H pylori

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21
Q

What are the 4 major causes of chronic gastritis? Where do they affect in stomach

A

ABCDs of chronic gastritis
Autoimmune (antiparietal cell antibodies affects body)
Bacterial (H pylori, affects antrum)
Chemical (NSAIDs, bile reflux, affects antrum)
D = IBD

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22
Q

Which types of neoplasm is H pylori associated with?

A

Adenocarcinoma
Lymphoma (MALToma)

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23
Q

How do some H pylori inject toxin into the mucosa?

A

Via cag A needle appendage (Cad A +ve h pylori have this)

(as they can’t directly invade epithelium)

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24
Q

Which strain of H pylori is associated with more aggressive chronic gastritis?

A

cag-A positive

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25
Why might you biopsy a gastric ulcer?
ALL gastric ulcers should be biopsied to exclude malignancy
26
What will be the result of a perforated gastric ulcer?
Peritonitis
27
What is gastric epithelial dysplasia?
Abnormal epithelial pattern of growth but no BMembrane invasion
28
What is the key cytological feature of gastric epithelial dysplasia?
High nuclear cytoplasmic ratio
29
What is the difference between gastric dysplasia and gastric cancer?
Invasion of basement membrane
30
What type of carcinoma is the most common type of gastric cancer?
Adenocarcinoma - 95%
31
Where is gastric cancer most common?
Japan, by far
32
What are the morphological categories of gastric cancer(specifically adenocarcinoma)?
Intestinal Diffuse aka signet ring = poor prognosis
33
What is the pattern of intestinal gastric adenocarcinoma?
Well-differentiated (mucin containing glands)
34
What is the pattern of diffuse gastric adenocarcinoma?
Poorly differentiated Signet ring cells, Linitis plastica
35
What is linitis plastica?
No focal lesion in stomach, but whole thing is thickened and static - due to diffuse adenocarcinoma
36
What is a gastrointestinal stromal tumour? (GIST)
Tumour of the interstitial cells of Cajal in the stomach - a SARCOMA
37
What is the cause of gastric MALToma?
Chronic inflammation, usually due to H pylori
38
What are gastric MALTomas composed of?
B cells
39
What is the first-line treatment of gastric MALToma?
H pylori treatment, could reverse lymphoma
40
Which type of gastrointestinal tract ulcers are always benign?
Duodenal
41
What is cryptosporidiosis?
Protozoal GIT infection causing diarrhoea seen in immunosuppressed patients
42
Where does giardia lamblia infection cause pathology?
Villi of GIT
43
What is the route of transmission of giardia?
Faeco/oral route
44
what cell damages villi in coeliac disease?
Cytotoxic T cells
45
In what condition are increased numbers of intraepithelial lymphocytes in the GIT seen?
Coeliac
46
What are the 3 main histological features of coeliac?
Crypt hyperplasia Villous atrophy Increased numbers of intraepithelial lymphocytes
47
Which two antibodies are required for diagnosis of coeliac disease?
``` Endomysial Tissue transglutaminase (TTG) ```
48
Where is MALToma associated with coeliac likely to be located?
Duodenum
49
What is the type of MALToma as a result of coeliac disease called?
Enteropathy associated T cell lymphoma
50
distinguish between ulcer and erosion
ulcer past muscularis mucosa (into submucosa) erosion before muscualris mucosa (not into submucosa)
51
define barrett's oesophagus
metaplastic process where squamous epithelium of lower oesophagus are replaced by columnar epithelium aka columnar lined epithelium
52
metaplasia vs dysplasia
Metaplasia: Transforms a cell from one form to another; caused by external stimulus; can be reversible; less likely to lead to cancer. Dysplasia: Transforms a cell into an abnormal version of itself; caused by internal stimulus; is not reversible; more likely to lead to cancer.
53
compare the histology of SCC of oesophagus and adenocarcinoma
SCC - invades submucosa, cells form keratin adenocarcinoma - glandular epithelium, mucin
54
which cells are involved in acute vs chronic gastritis
``` acute = neutrophils chronic = lymphocytes ```
55
define malt. what do you see on stomach biopsy
lymphoma associated lymphoid tissue = chronic gastritis associated w h pylori biopsy - lymphoid follicles = highly suggestive of H pylori as not normal
56
what cancers do atrophic vs non-atrophic gastritis progress to
``` atrophic = adenocarcinoma non-atrophic = MALToma ```
57
antrum predominant gastritis progresses to?
duodenal ulcer
58
outline the 2 pathways that lead to GI cancers
metaplasia-dysplasia pathway = upper GI e.g oesophageal cancer adenoma-carcinoma pathway = lower GI e.g colon cancer
59
give an example of a neuroendocrine tumour of the stomach. what condition is this seen in sometimes
Zollinger Ellison syndrome a condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers. 25% time linked to MEN1
60
overall survival rate of gastric cancer
15%
61
what 3 histological changes are seen in coeliac disease
``` villous atrophy (flat villi) crypt hyperplasia increases intraepithelial lymphocytes ```
62
give the diagnostic criteria of coeliac disease
endomysial antibodies - anti EMA tissue transglutaminase antibodies - anti TTG AND a biopsy on gluten rich diet showing villous atrophy off gluten rich diet showing normal villi

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